Name of the Procedure:

Saline Infusion Sonohysterography (SIS), also known as saline sonography or hysterosonography, with Color Flow Doppler

Summary

Saline infusion sonohysterography (SIS) is a minimally invasive ultrasound procedure that provides detailed images of the uterine cavity. During the procedure, saline solution is infused into the uterus, and ultrasound images are obtained to evaluate the presence of abnormalities. Color flow Doppler is often used to assess blood flow within and around the uterus.

Purpose

SIS is used to identify and evaluate various uterine abnormalities such as fibroids, polyps, scar tissue, and congenital anomalies. The primary goal is to diagnose the cause of abnormal uterine bleeding, infertility, or recurrent miscarriages and to guide treatment decisions.

Indications

• Abnormal uterine bleeding
• Infertility or recurrent miscarriages
• Suspected uterine fibroids, polyps, or adhesions
• Assessment of the uterine cavity before in vitro fertilization (IVF)
• Evaluation of uterine congenital anomalies

Preparation

• The patient may be instructed to schedule the procedure early in the menstrual cycle.
• A pregnancy test may be required to ensure the patient is not pregnant.
• The patient may need to empty their bladder before the procedure.
• Discuss any medications with the healthcare provider; certain medications may need to be adjusted.

Procedure Description

1. The patient lies on an examination table, usually in a position similar to that for a pelvic exam.
2. A speculum is inserted into the vagina to allow access to the cervix.
3. A catheter is gently inserted through the cervix into the uterine cavity.
4. Sterile saline solution is infused through the catheter into the uterus to expand the cavity for better visualization.
5. Transvaginal ultrasound is performed to obtain detailed images of the uterine cavity.
6. Color flow Doppler imaging may be used to assess blood flow within the uterine tissues.

Duration

The procedure typically takes about 15-30 minutes.

Setting

SIS is usually performed in an outpatient clinic or an imaging center.

Personnel

The procedure is performed by a radiologist or a gynecologist with assistance from a nurse or ultrasound technician.

Risks and Complications

• Mild cramping or discomfort during the procedure
• Vaginal spotting or discharge after the procedure
• Rarely, infection or injury to the uterus or cervix
• Allergic reaction to the saline solution (extremely rare)

Benefits

• Provides detailed images of the uterine cavity
• Helps diagnose the cause of abnormal uterine bleeding or infertility
• Non-invasive and relatively quick procedure
• Can guide further treatment decisions

Recovery

• Most patients can resume normal activities immediately after the procedure.
• Patients may experience mild cramping or spotting for a few days.
• Follow-up appointments may be scheduled to discuss the results and next steps.

Alternatives

• Hysterosalpingography (HSG), which uses X-rays and contrast dye
• Diagnostic hysteroscopy, which involves direct visualization of the uterine cavity with a camera
• Pelvic MRI for detailed imaging without using saline infusion
• Each alternative has its own pros and cons in terms of invasiveness, detail of imaging, and specific applications.

Patient Experience

• Patients may feel mild discomfort or cramping during the infusion of the saline.
• The use of ultrasound is generally painless.
• Pain management measures, such as over-the-counter pain relievers, may be recommended for any post-procedure discomfort.
• Communication with the healthcare team helps ensure comfort and understanding of each step of the procedure.